Mesenchymal Stem Cells as an Alternative to Knee

Mesenchymal Stem Cells as an Alternative to Knee Replacement Surgery Elizabeth Hartman, Ph. D, RN, Michelle Villegas-Downs, MS, RN De. Paul University, Chicago, IL 60604 BACKGROUND • Knee osteoarthritis is a chronic, degenerative disease that indiscriminately affects all races, ages and genders • Current estimates indicate that by 2030, 67 million Americans will suffer from knee osteoarthritis • The treatment option for knee osteoarthritis is total knee replacement surgery, which carries significant risks for complications • Recent research has proposed the use of mesenchymal stem cells as a non-operative treatment modality for knee osteoarthritis PURPOSE • Investigate the safety and efficacy of mesenchymal stem cell injections as a treatment modality for patients with osteoarthritis • Evaluate patient outcomes when using mesenchymal stem cell injections as treatment for knee cartilage repair RESEARCH QUESTIONS 1. Have clinical trials been conducted using mesenchymal stem cells as a treatment modality for knee cartilage repair in patients with osteoarthritis? 2. What are the risks of injecting mesenchymal stem cells into damaged knee cartilage? 3. What are the reported benefits stated by clients who have undergone mesenchymal stem cell injections? MATERIALS AND METHODS • A systematic integrated literature review search within the databases CINAHL Complete and Pub. Med • Terms that were searched while researching the topic include mesenchymal stem cells and knee osteoarthritis Pub Med CINAHL Complete Number of studies found using keywords 227 42 Number of studies meeting inclusion criteria 98 10 Number of studies after excluding duplicates 88 10 Number of Studies after exclusion criteria 23 7 Number of studies selected based on total content 7 Total number of papers utilized 3 10 RESULTS • Mesenchymal stem cells can effectively regenerate cartilage by self-renewing and differentiating into chondrocytes, adipocytes, and osteocytes • Studies in the clinical phase have reported increased cartilage growth, better joint function and less pain for clients treated with mesenchymal stem cell injections • Selecting the appropriate mesenchymal stem cell retrieval and application method can lead to a stronger therapeutic response • Pain after the procedure was the most common adverse effect reported post mesenchymal stem cell injection • Patients receiving bone marrow concentrate reported the least adverse effects • Results in the pre-clinical and clinical phase have demonstrated the efficacy and safety of mesenchymal stem cell use for the treatment of knee osteoarthritis CONCLUSION • Knee osteoarthritis is a degenerative disease that causes a myriad of symptoms including disability and persistent pain • Presently, the treatment of choice for chronic knee osteoarthritis is total knee replacement surgery • The findings of this literature review show regenerative medicine is a safe and effective treatment modality for joint preservation and restoration in knee osteoarthritis FUTURE DIRECTION • A standard protocol for mesenchymal stem cell retrieval, implantation and follow-up procedure must be established • Large scale studies must be conducted to determine the long term safety and efficacy of mesenchymal stem cell use for the treatment of knee osteoarthritis before the procedure becomes standard practice NURSING IMPLICATIONS • Nurses can educate patients on alternative treatment options available for knee osteoarthritis; thus, opening the opportunity to enroll patients into active clinical trials • Nurses must be able to recognize and advocate for patients that would benefit from alternative treatments like mesenchymal stem cell injections before their condition progresses significantly enough that total knee replacement is inevitable • Nurses can use their advocacy skills to improve and change health policy, thereby influencing the way the government makes health care decisions and allocates funding for research REFERENCES Centeno, C. 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